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General NPI Number Information
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NPI Number | 1831185818
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Entity Type | Individual
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Provider Name | JEFF LEE DAVIE D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 1181 S STATE ROUTE 157 SUITE 200C
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3710
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Country | US
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Telephone | 618-288-4100
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Fax | 618-307-3283
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Provider Business Mailing Address
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Address Line | 916 TALON DR SUITE 102
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City | O FALLON
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State | IL
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Zip | 62269-1848
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Country | US
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Telephone | 618-628-8211
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Fax | 618-628-0883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CE006572
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038011166
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License Number State | IL
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